Issue
Number 490
November 8, 2004
CONTENTS OF THIS ISSUE
- Immunization community mourns the death of Dr. John LaMontagne, NIAID
deputy director
- Clinician alert: Take time today to register for CDC's Influenza
Update Net Conference
- IFAS and CDC educate patients and professionals about pneumococcal
disease and vaccine
- Don't miss out: Order IAC's "Adults Only Vaccination" kit while
supplies last
- CDC continues to update its Web materials related to the current
influenza vaccine shortage
- 2003 influenza and pneumococcal vaccination rates for elderly and some
high-risk persons fell short of national objectives
- CDC reports 89% decrease in acute hepatitis B infection among U.S.
children and adolescents during 1990-2002
- National Influenza Vaccine Summit's home page offers broad overview of
current and ongoing influenza-vaccination issues
- CDC reports on reasons Medicare beneficiaries age >=65 years failed to
receive influenza vaccination during 1991-2002
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ABBREVIATIONS: AAFP, American Academy of Family Physicians; AAP, American
Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices;
CDC, Centers for Disease Control and Prevention; FDA, Food and Drug
Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and
Mortality Weekly Report; NIP, National Immunization Program; VIS, Vaccine
Information Statement; VPD, vaccine-preventable disease; WHO, World Health
Organization.
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November 8, 2004
IMMUNIZATION COMMUNITY MOURNS THE DEATH OF DR. JOHN LAMONTAGNE, NIAID DEPUTY
DIRECTOR
John R. LaMontagne, PhD, deputy director of the National Institute of
Allergy and Infectious Diseases (NIAID) of the National Institutes of Health
(NIH), died suddenly in Mexico City on November 2, 2004. He was 61. Excerpts
from a statement released by NIH follow.
***********************
"All of us are profoundly saddened by the loss of John LaMontagne," said
NIAID Director Anthony S. Fauci, MD. "Personally, he was a dear friend and
one of the finest people I have ever known. Professionally, in an NIH career
spanning nearly 30 years, his leadership and commitment to improving global
health were remarkable. His generosity, wit, even-handedness, and kindness
made him a friend to all who knew him. He will be sorely missed. . . ."
Dr. LaMontagne, a native of Mexico City, Mexico, received his PhD from
Tulane University in 1971. In 1976, he came to NIH as the influenza program
officer at the NIAID. He became the program officer for the Viral Vaccines
Program in 1983, and the influenza and viral respiratory diseases program
officer in 1984. Beginning in 1986, Dr. LaMontagne assumed the role of
director of the AIDS Program. In 1987 he was appointed director of the
Microbiology and Infectious Diseases Program, which became a division in
1988. Dr. LaMontagne was appointed deputy director of the NIAID in February
1998.
Dr. LaMontagne made significant contributions to the national and
international effort against emerging and re-emerging infectious diseases,
including biodefense-related activities, and has been recognized
internationally for his leadership in this area. He played a central role in
the organization of the Multilateral Initiative on Malaria, an international
effort involving research, control, and development agencies from the U.S.,
Europe, and Africa. In addition, he served as a member of the Scientific
Advisory Groups of Experts on Vaccines and Biologicals as well as for
Vaccines and Immunization for the World Health Organization. He chaired the
WHO Task Force on Strategic Planning for the Children's Vaccine Initiative,
advised the Pan American Health Organization on their programs in vaccine
research implementation, and served as a member of the board of the Global
Alliance for Tuberculosis Drug Development. Dr. LaMontagne also served as a
member of the Biomedical Research Confederation Executive Steering Committee
at Ft. Detrick, Maryland, and as co-chair of the Research and Development
Gaps Working Group, a component of the Weapons of Mass Destruction
Subcommittee of the National Science and Technology Council. His outstanding
administrative leadership at NIH included membership on the NIH Community
Advisory Board for Security and the recently formed NIH Ethics Advisory
Committee.
As an influential contributor to the field of
infectious diseases, Dr. LaMontagne delivered numerous major lectures all
over the world. He received many prestigious awards for his scientific
accomplishments, including the PHS Special Recognition Award for leadership
in childhood vaccine research programs, the Surgeon General's Certificate of
Appreciation, the Presidential Meritorious Executive Rank Award, the
Distinguished Executive Award for his work in the areas of infectious
diseases research of global health relevance, the Secretary's Award for
Distinguished Service for leadership of acellular pertussis vaccine trials,
and most recently the Secretary's Award for Distinguished Service for design
and implementation of critically important biodefense strategies.
***********************
To access the entire statement, go to:
http://www2.niaid.nih.gov/newsroom/releases/lamontagne.htm
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November 8, 2004
CLINICIAN ALERT: TAKE TIME TODAY TO REGISTER FOR CDC'S INFLUENZA UPDATE NET
CONFERENCE
Scheduled for November 19 from 12PM to 1PM (ET), the next Influenza Update
Net Conference will provide clinicians with the most up-to-date information
on influenza. This is a limited-registration event; registration closes
November 18 at midnight (ET) or when the course is full. Don't be
disappointed, register NOW by going to
http://www2.cdc.gov/nip/isd/fluconference
The conference presenters are immunization experts from CDC; the conference
agenda follows:
- Introduction by moderator Dr. William
Atkinson
- Influenza Vaccine Supply Update by Dr. Ray
Strikas
- Antiviral Medications for Influenza by Dr.
Tim Uyeki
- Infection Control Measures to Prevent
Influenza Transmission by Dr. Arjun Srinivasan
The program will combine a telephone audio
conference with simultaneous online visual content. It will include a Q&A
session, accessible by telephone and Internet. Internet access and a
separate phone line are needed to participate. For more information, see
Instructions and System Requirements at
http://www.cdc.gov/nip/ed/ciinc/instructions.htm
Graphics will be available to download as a PowerPoint file after the
presentations. A replay of the web cast will be available within 24 hours of
the conference.
For additional information, go to:
http://www.cdc.gov/flu/professionals/training/novnetconf.htm
If you have questions, direct them to Clinician Outreach and Communication
Activity at COCA@cdc.gov
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November 8, 2004
IFAS AND CDC EDUCATE PATIENTS AND PROFESSIONALS ABOUT PNEUMOCOCCAL DISEASE
AND VACCINE
The Institute for the Future of Aging Services (IFAS) and CDC have recently
made patient- and professional-education material available on the topic of
pneumococcal disease and pneumococcal polysaccharide vaccine (PPV23). With
the current shortage of influenza vaccine, it is important that the public
and health professionals realize the benefits of PPV23 for high-risk
persons. In addition to reducing the risk for invasive pneumococcal disease,
PPV23 also reduces complications of influenza infection. CDC estimates that
supplies of the vaccine are adequate to meet expected demand.
IFAS PATIENT-EDUCATION BROCHURE
IFAS's patient-education brochure, "Pneumococcal Disease: Learn about how
you can protect yourself from a leading killer of older people," urges older
adults to receive PPV23. In addition to discussing the vaccine, the brochure
describes the disease, its associated health risks, and the steps older
people can take to prevent it.
To access a ready-to-print (PDF) version of it, go to:
http://www.futureofaging.org/PublicationFiles/Pneumonia.pdf
For additional information, contact Natasha Bryant by phone at (202)
508-1214 or by email at
nbryant@aahsa.org
CDC'S WEB-BASED RESOURCES FOR PATIENTS AND PROFESSIONALS
A gateway to a broad array of materials for patients and professionals,
CDC's "Pneumococcal Disease" web section directs users to a bi-lingual
(English-Spanish) patient-education brochure, the ACIP recommendations, the
Pink Book, the VIS for PPV23, and much more.
To access the "Pneumococcal Disease" web section, go to:
http://www.cdc.gov/nip/diseases/Pneumo/default.htm
PLEASE NOTE: The current VIS for PPV23 (dated 7/29/97) is available on the
IAC website in eleven languages in addition to English. To access them, go
to:
http://www.immunize.org/vis/index.htm#pneumococcal
For information about the use of VISs, and for VISs in a total of 32
languages, visit IAC's VIS web section at
http://www.immunize.org/vis
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November 8, 2004
DON'T MISS OUT: ORDER IAC'S "ADULTS ONLY VACCINATION" KIT WHILE
SUPPLIES LAST
In the past few weeks, IAC has received orders for substantial
numbers of its immunization-delivery resource "Adults Only
Vaccination: A Step-by-Step Guide" (the AOV kit). We have about
200 left and have no plans to produce more. If you want one (or
more), place an order NOW! Ordering information is at the end of
this article.
WHAT IS THE AOV KIT? IAC produced the kit to help health
professionals in settings such as STD clinics, family planning
clinics, college health services, OB/GYN practices, and prisons
vaccinate their adult patients. The kit pares down immunization
delivery to its essential components and presents each component
in manageable, easy-to-master steps. The steps progress in
logical order, starting with setting up a vaccine service at
your site and ending with billing for the vaccine services
you've delivered.
WHO NEEDS THE KIT? Designed to help integrate immunization
services into sites new to vaccination, the AOV kit is equally
valuable for settings experienced in vaccine delivery. Why?
Because it puts ALL the information you need to vaccinate adults
right at your fingertips. If you currently find any aspect of
adult vaccination confusing, the kit will clarify the issue or
give you resources for getting clarification. IF YOU VACCINATE
ADULTS, YOU CAN'T AFFORD TO BE WITHOUT THE KIT.
WHAT'S IN THE KIT? The heart of the kit is the guide, which
presents 157 pages of comprehensive, authoritative, CDC-reviewed
information on ALL aspects of adult immunization. Organized into
seven logically presented steps, the guide is designed to be
useful and stay current for years: it has more than 45 patient
and provider-education materials that will never go out of date
because each is linked to the latest version on IAC's website.
Plus, the guide is tabbed for easy reference, spiral bound to
lie flat, and plastic coated for durability. And, it has wide
margins for jotting down practical information such as useful
web and email addresses, ideas for improving certain aspects of
vaccine delivery, etc. This allows you to customize your guide
to suit your clinic or practice's unique needs.
In addition to the guide, the kit contains the following:
- Two "how-to" instructional videos--"Immunization Techniques:
Safe, Effective, Caring" (produced by California Distance
Learning Health Network in 2001) and "How to Protect Your
Vaccine Supply" (produced by CDC in 2004)
- Standing orders protocols for administering eight vaccines
commonly given to adults; these are indispensable for
increasing your clinic or practice's adult immunization rates
- Vital information for responding to vaccine-related medical
emergencies, such as anaphylaxis, or to power outages
- A pack of 25 adult immunization record
cards
CAN I GET MORE INFORMATION ABOUT THE KIT? You can get complete
information--including a look at the guide's many worksheets,
checklists, protocols, and educational materials--by visiting
IAC's website at http://www.immunize.org/guide
WHO SUPPORTS THE KIT? Immunization experts from NIP/CDC reviewed
the kit. In addition, the following government agencies signed
the guide's introductory letter: US Department of Health and
Human Services (Women's Health); several divisions within CDC:
the Division of HIV/AIDS Prevention, Division of Sexually
Transmitted Diseases Prevention, and Division of Viral
Hepatitis. The following professional organizations also signed
the letter: the American College Health Association, American
College of Obstetricians and Gynecologists, American Medical
Association, National Medical Association, and Planned
Parenthood Federation of America.
WHAT'S THE PRICE? The kit costs $75. Special discount pricing is
available for orders of 10 copies or more (see the link below).
HOW CAN I ORDER THE KIT? You can order online or by fax or mail,
using a credit card, purchase order, or check. To order, go to:
http://www.immunize.org/guide Click on the
appropriate link.
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November 8, 2004
CDC CONTINUES TO UPDATE ITS WEB MATERIALS RELATED TO THE CURRENT
INFLUENZA VACCINE SHORTAGE
CDC recently updated its website with several new documents
related to the influenza vaccine shortage. Following are links
to the new information.
PROFESSIONAL INFORMATION
(1) The two-page flyer "Colleges and Universities: 2004-05
Influenza Season" is a collection of information and resources
for college health services.
To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/flu/school/pdf/college.pdf
To access a web-text (HTML) version, go to:
http://www.cdc.gov/flu/school/college.htm
(2) The three-page flyer "Questions and Answers: Information for
Schools" is a collection of Q&As and resources for school
administrators, teachers, staff, and parents.
To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/flu/school/pdf/qa.pdf
To access a web-text (HTML) version, go to:
http://www.cdc.gov/flu/school/qa.htm
PATIENT INFORMATION
(3) The patient self-screening questionnaire "Patient Screening
Form: Who Should and Who Should Not Get a Flu Shot?" is now
available in Spanish: "Quien debe y quien no debe ponerse la
vacuna contra la gripe?"
To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/flu/professionals/flugallery/pdf/vaccinescreeningform-spa.pdf
(4) Two questions have been added to "Questions & Answers: The
Disease." To access them, go to:
http://www.cdc.gov/flu/about/qa/disease.htm
(5) Two questions have been added to "Questions & Answers:
Preventing the Flu." To access them, go to:
http://www.cdc.gov/flu/about/qa/preventing.htm
(6) Patient information sheets are now available in Romanian. To
access them, go to: http://www.cdc.gov/flu/languages.htm#rom
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November 8, 2004
2003 INFLUENZA AND PNEUMOCOCCAL VACCINATION RATES FOR ELDERLY
AND SOME HIGH-RISK PERSONS FELL SHORT OF NATIONAL OBJECTIVES CDC published "Influenza and Pneumococcal Vaccination Coverage
Among Persons Aged >=65 Years and Persons Aged 18-64 Years with
Diabetes or Asthma--United States, 2003" in the November 5 issue
of MMWR. Portions of the article are reprinted below.
***********************
[From the article]
Vaccination of persons at risk for complications from influenza
and pneumococcal disease is a key public health strategy for
preventing associated morbidity and mortality in the United
States. Risk factors include older age and medical conditions
that increase the risk for complications from infections. During
the 1990-1999 influenza seasons, more than 32,000 deaths each
year among persons aged >=65 years were attributed to
complications from influenza infection. National health
objectives for 2010 call for 90% influenza and pneumococcal
vaccination coverage among noninstitutionalized persons aged
>=65 years and 60% coverage among noninstitutionalized persons
aged 18-64 years who have risk factors (e.g., diabetes or
asthma) for complications from infections (objective nos.
14.29a-d). To estimate influenza and pneumococcal vaccination
coverage among these populations, CDC analyzed data from the
2003 Behavioral Risk Factor Surveillance System (BRFSS) survey.
This report summarizes the results of that analysis, which
indicated that (1) influenza vaccination levels among adults
aged 18-64 with diabetes or asthma, (2) pneumococcal vaccination
levels among adults aged 18-64 years with diabetes, and
(3) influenza and pneumococcal vaccination levels among adults
aged >=65 years all were below levels targeted in the national
health objectives for 2010. Moreover, vaccination coverage
levels varied among states for both vaccines and both age
groups. Innovative approaches and adequate, reliable supplies of
vaccine are needed to increase vaccination coverage,
particularly among adults with high-risk conditions. . . .
In 2003, of respondents aged >=65 years, influenza vaccination
coverage levels during the preceding 12 months ranged from 34.9%
[United States Virgin Islands (USVI)] to 80.3% (Minnesota), with
a median of 69.9%. Among respondents aged >=65 years, the
proportion reporting ever having received pneumococcal vaccine
ranged from 31.6% (USVI) to 73.0% (Minnesota), with a median of
64.2%. Compared with 2002, a total of 41 and 38 states/areas
experienced increases in influenza and pneumococcal coverage
among those aged >=65 years, respectively; 11 of these increases
were statistically significant for each vaccine.
Among adults aged 18-64 years with asthma or diabetes,
substantial variation in vaccination coverage by area also was
observed. For respondents with asthma, median influenza coverage
was 34.0% and ranged from 22.5% (Puerto Rico) to 46.6%
(Wyoming). Influenza vaccination rates among persons with asthma
were higher among persons aged 50-64 years (median: 53.4%;
range: 27.6%-74.9%) than among persons aged 18-49 years (median:
27.7%; range: 16.6%-41.1%). For respondents with diabetes,
median influenza coverage was 49.0% and ranged from 26.5%
(Puerto Rico) to 62.4% (South Dakota); the median pneumococcal
coverage was 37.1% and ranged from 19.5% (Puerto Rico) to 58.2%
(Montana). For persons with diabetes, vaccination rates were
higher among those aged 50-64 years (for influenza, median:
56.5%; range: 23.7%-73.1% and for pneumococcal, median: 42.6%;
range: 19.7%-68.1%) than among persons aged 18-49 years (for
influenza, median: 37.8%; range: 22.2%-59.9% and for
pneumococcal, median: 28.3%; range: 13.3%-56.7%).
[From the Editorial Note]
The findings in this report indicate an increase in influenza
and pneumococcal vaccination coverage for the majority of areas
from 2002 to 2003 among adults aged >=65 years; however,
coverage among persons indicated for these vaccinations remains
below the national health objectives for 2010. In addition,
almost half of the states reported >50% influenza coverage
levels for participants aged 18-64 years with diabetes; however,
the median coverage level of influenza vaccination among
participants with asthma and the median coverage level of
pneumococcal vaccines among participants with diabetes were
below the 2010 target of 60% for noninstitutionalized adults at
high risk. Among respondents with asthma and diabetes, those
aged 18-49 years had substantially lower vaccination coverage
than those aged 50-64 years.
Lack of awareness of the need for vaccination is common among
adults aged <65 years with high-risk conditions, such as
diabetes or asthma. In a 2003 survey, approximately 75% of
unvaccinated persons aged 18-64 years with diabetes reported
that they were unaware of the need for influenza vaccine
(CDC, unpublished data, 2003). Although use of preventive health
services by adults with diabetes has increased since 1995, a
substantial proportion of generalist and subspecialist
physicians did not strongly recommend influenza and pneumococcal
vaccinations to their patients who are elderly or at high risk.
Low vaccination rates among persons with high-risk conditions
might reflect the challenge of targeting patients for
vaccinations on the basis of high-risk conditions instead of
age. Although a majority of patients seen by subspecialists
might be those who most need vaccination, subspecialists might
not perceive the provision of preventive services as their role.
Primary care physicians and subspecialists should work together
to ensure that persons at high risk receive appropriate
vaccinations. In addition, strategies to increase awareness
among young adults of the need for vaccinations could be
emphasized by diabetes- and asthma-care programs. The Diabetes
Quality Improvement Project, a collaborative effort between
public and private organizations to improve preventive care for
persons with diabetes, has been ongoing since 1995; this effort
is one possible reason for the higher influenza vaccination
rates among those with diabetes compared with those with
asthma. . . .
The variation in influenza and pneumococcal vaccination coverage
observed among areas suggests that vaccination coverage can be
improved. Previous studies have indicated that organizational
changes, such as nurse standing orders, combined with teamwork
and collaboration, are effective intervention measures for
increasing adult vaccination services. Effective measures to
promote the use of such measures are needed for vaccination
rates to increase.
Because of the 2004 influenza vaccine shortage, vaccine
providers have been asked to direct available inactivated
influenza vaccine to persons with chronic conditions, such as
diabetes and asthma, and other priority groups. Further analysis
of influenza vaccine coverage data will be needed to assess the
impact of this shortage on influenza vaccine coverage and
efforts to redirect vaccine to persons at greatest risk for
influenza complications. Ensuring adequate amounts of influenza
vaccine is critical if vaccination rates of persons at high risk
are to continue improving. Pneumococcal vaccine supplies appear
to be adequate to meet expected demand. Pneumococcal vaccination
should be encouraged for populations at high risk, both to
reduce the risk for invasive pneumococcal disease itself and to
reduce complications of influenza infection.
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To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5343a2.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5343.pdf
To receive a FREE electronic subscription to MMWR (which
includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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November 8, 2004
CDC REPORTS 89% DECREASE IN ACUTE HEPATITIS B INFECTION AMONG
U.S. CHILDREN AND ADOLESCENTS DURING 1990-2002
CDC published "Acute Hepatitis B Among Children and
Adolescents--United States, 1990-2002" in the November 5 issue
of MMWR. The article is reprinted below in its entirety,
excluding references, two figures, and a table.
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Since the 1991 adoption of a comprehensive strategy to eliminate
hepatitis B virus (HBV) transmission in the United States, the
incidence of acute hepatitis B cases has declined steadily.
Declines have been greatest among children born after the 1991
recommendations for universal infant hepatitis B vaccination
were implemented. In 1995, the elimination strategy was expanded
to include routine vaccination of all adolescents aged 11-12
years and, in 1999, to include children aged <18 years who had
not been vaccinated previously. To describe the epidemiology of
acute hepatitis B in children and adolescents in the United
States, CDC analyzed notifiable disease surveillance data
collected during 1990-2002 and data collected during 2001-2002
through enhanced surveillance of reported cases of acute
hepatitis B in children born after 1990. This report summarizes
the results of that analysis, which indicated that the rate of
acute hepatitis B in children and adolescents decreased 89%
during 1990-2002 and that racial disparities in hepatitis B
incidence have narrowed. Many confirmed cases in persons born
after 1990 occurred among international adoptees and other
children born outside the United States. Continued
implementation of the hepatitis B elimination strategy and
accurate surveillance data to monitor the impact of vaccination
are necessary to sustain the decline of acute hepatitis B among
children.
Cases of acute hepatitis B were reported weekly to CDC by all
50 states and the District of Columbia. Acute hepatitis B rates
were calculated per 100,000 population by using population
denominators from the U.S. Census Bureau. Acute hepatitis B was
defined as an acute illness with (1) discrete onset of symptoms
and jaundice or elevated serum aminotransferase levels and
(2) laboratory evidence of either IgM antibody to hepatitis B
core antigen (IgM anti-HBc) or hepatitis B surface antigen
(HBsAg). Since March 2001, CDC has conducted enhanced
hepatitis B surveillance, contacting states to confirm all
reported cases of acute hepatitis B in persons born after 1990.
State surveillance staff members were asked to verify each of
the items in the case definition and provide information
regarding vaccination history and country of birth. If errors
were identified during this process, states were asked to
correct the information in an updated submission to CDC.
National Surveillance
During 1990-2002, a total of 13,829 cases of acute hepatitis B
were reported in the United States among persons aged
<=19 years. The incidence of reported cases declined steadily
during this period, from 3.03 per 100,000 population in 1990 to
0.34 in 2002, representing a decline of 89%. The incidence among
adolescents aged 15-19 years was consistently higher than the
incidence among younger age groups, ranging from 8.69 per
100,000 population in 1990 to 1.13 in 2002. Children and
adolescents in all age groups experienced steep declines in
incidence during 1990-2002; incidence declined 94% among
children aged 0-4 years, 92% among children aged 5-9 years, 93%
among those aged 10-14 years, and 87% among adolescents aged
15-19 years.
Among children and adolescents aged <=19 years in 1990,
incidence per 100,000 population was highest among Asian/Pacific
Islanders (A/PIs) (6.74) and blacks (4.29); whites had the
lowest race-specific incidence (1.39). Differences in incidence
between whites and A/PIs and between whites and blacks were 5.34
and 2.90, respectively. From 1990 to 2002, rates declined 92%
among A/PIs, 88% among whites, 88% among blacks, and 84% among
American Indians/Alaskan Natives (AI/ANs). In 2002, the highest
incidence per 100,000 population was among A/PIs (0.55),
followed by blacks (0.51), AI/ANs (0.43), and whites (0.16);
since 1990, differences in incidence between whites and A/PIs
and whites and blacks declined by 93% and 88%, respectively.
Case Investigations
Follow-up investigations conducted by CDC and state and local
health departments verified 19 case reports from 2001 and 2002
as cases of acute hepatitis B among children born after 1990. Of
the verified case reports, 12 (60%) involved males, eight (42%)
involved children aged <2 years, and 11 (58%) involved children
born in the United States. Seven (37%) reported race as A/PI,
five (26%) as white, four (21%) as black, and three (16%) as
unknown. Eight (42%) cases were reported in children born
outside the United States, including six international adoptees
(32%). Receipt of >=1 dose of hepatitis B vaccine was confirmed
in three (16%) cases. Vaccination status was unknown for
12 cases (63%).
Editorial Note:
The incidence of acute hepatitis B cases in U.S. children and
adolescents decreased during the era of universal childhood
vaccination. This decline coincided with an increase in
hepatitis B vaccination coverage among children aged
19-35 months, from 16% in 1992 to 90% in 2002, and among
adolescents aged 13-15, from nearly 0 in 1992 to 67% in 2002.
Declines in incidence were observed for children of all races,
including A/PIs, whose rates historically have been higher than
the national average. Because of the disproportionate burden of
hepatitis B in A/PI communities, A/PI children were among the
first groups for whom hepatitis B vaccination was recommended.
The reduction of the disparity between A/PIs and other children
is consistent with recent observations noting a decline in
seroprevalence of HBV infection and successful implementation of
routine hepatitis B vaccination among Asians who have recently
immigrated to the United States. However, of the 11 verified
cases during 2001-02 of acute hepatitis B among children born in
the United States, three (27%) involved A/PIs. Although the
national origins of these children's household members are
unknown, the substantial proportion of A/PIs suggests that
horizontal transmission of HBV among first-generation Asians
might be a persistent problem.
The higher incidence among older adolescents (aged 15-19 years)
likely is attributable to their having been born before
universal infant hepatitis B vaccination was recommended in
1991. Incidence among older adolescents is expected to decline
further as the vaccinated cohort ages and as 1999
recommendations to vaccinate all previously unvaccinated persons
aged 0-18 years are fully implemented. The expected decline in
rates among adolescents also might be augmented by laws in
32 states requiring proof of hepatitis B vaccination before
entry into middle school.
Follow-up information obtained through surveillance of reported
cases suggests that children born outside the United States,
especially international adoptees, represent a substantial
proportion of cases. Cases of acute hepatitis B among
international adoptees might result from undervaccination and
increased risk for exposure while living in areas with high
prevalence of chronic HBV infection. International adoptees are
exempt from U.S. regulations that bar entry to immigrants
without documentation of hepatitis B vaccination. Studies have
demonstrated that international adoptees exhibit low rates of
protective titers of antibodies to vaccine-preventable diseases
upon arrival in the United States, including adoptees with
written evidence of age-appropriate vaccination provided by the
birth country. Appropriate evaluation and remediation of the
immunization status of international adoptees has been promoted
through national guidelines; however, the extent to which these
guidelines have been implemented is unknown.
Despite the decline in acute hepatitis B cases among children in
the United States, the presence of confirmed cases highlights
the importance of infant vaccination and timely completion of
the 3-dose vaccination series. The vaccination series should be
started at birth, preferably before the newborn is discharged
from the hospital. Infants born to women who are HBsAg positive
or who have not had prenatal HBsAg testing should receive the
first dose of hepatitis B vaccine within 12 hours of birth.
Beginning the vaccination series at birth decreases the risk for
perinatal HBV transmission and predicts successful completion of
the series.
Although enhanced surveillance data from verified case reports
suggest that international adoptees and other children born
outside the United States might particularly benefit from future
prevention efforts, many case reports lacked risk factor
information. As the incidence of acute hepatitis B among
children and adolescents declines, accurate surveillance data
become increasingly important to monitor the effect of
immunization recommendations. Continued efforts of local, state,
and national surveillance staff to improve data quality are
critical to eliminating HBV transmission in the United States.
***********************
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5343a4.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5343.pdf
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November 8, 2004
NATIONAL INFLUENZA VACCINE SUMMIT'S HOME PAGE OFFERS BROAD
OVERVIEW OF CURRENT AND ONGOING INFLUENZA-VACCINATION ISSUES
A partnership of more than 50 organizations cosponsored by CDC
and the American Medical Association (AMA), the National
Influenza Vaccine Summit offers health professionals an array of
influenza-immunization resources on its home page. Located on
the AMA website, the home page includes information from
CDC/ACIP, the American Medical Association, PKIDS (Parents of
Kids with Infectious Diseases), IAC, and other organizations. It
also contains information about the summit's annual meetings. To access the home page, go to:
http://www.ama-assn.org/ama/pub/article/1826-8377.html
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November 8, 2004
CDC REPORTS ON REASONS MEDICARE BENEFICIARIES AGE >=65 YEARS
FAILED TO RECEIVE INFLUENZA VACCINATION DURING 1991-2002
CDC published "Influenza Vaccination and Self-Reported Reasons
for Not Receiving Influenza Vaccination Among Non-Institutionalized Medicare Beneficiaries Aged >=65 Years--United
States, 1991-2002" in the November 5 issue of MMWR. A summary
made available to the press is reprinted below in its entirety.
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Annual influenza vaccination coverage among Medicare
beneficiaries has been increasing since 1991, but increases are
threatened by a lack of knowledge among the elderly about the
benefits of the vaccine, as well as the potential for disruption
in vaccine supplies. From 1991-2002, the Medicare Current
Beneficiaries Survey (MCBS) shows a steady upward trend in
influenza vaccination coverage among Medicare beneficiaries
65 years of age and older. The exception to this upward trend
occurred during the 2000-2001 influenza season, in which vaccine
distribution was delayed. Vaccine unavailability was reported as
a reason for nonvaccination by respondents for the first time in
2000-2001. However, the most frequently cited survey reasons for
not receiving influenza vaccine were not knowing that influenza
vaccination was needed and concerns that vaccination might cause
influenza or side effects, indicating that further efforts are
needed to educate the elderly regarding the benefits of
influenza vaccination.
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To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5343a3.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5343.pdf |
